Washington Medicaid reimbursement rates
42,408 current fee-for-service and managed-care rates from Washington Medicaid, across 126 services and 24 programs, normalized by code, provider level and unit. Each links to one of 584 official source documents.
Last retrieved 2026-10-02. History back to 2006-07-01.
- Current rates
- 42,408
- Services
- 126
- Programs
- 24
- Lines with a plan rule
- 14of 22 service lines
By industry
Applied behavior analysis (ABA)Washington rates, labor costs and changesBehavioral healthWashington rates, labor costs and changesHome healthWashington rates, labor costs and changesHome care & personal careWashington rates, labor costs and changesPrivate duty nursingWashington rates, labor costs and changesSkilled nursing facilitiesWashington rates, labor costs and changesHospiceWashington rates, labor costs and changesIntellectual & developmental disabilitiesWashington rates, labor costs and changesOutpatient therapy (PT, OT, speech)Washington rates, labor costs and changes
Washington rates by service
The median current rate for each service, like-for-like by unit. Follow a service to compare it with every other state.
| Service | Line | Median rate | Unit | Per hour | Variants |
|---|---|---|---|---|---|
| ABA assessment by a behavior analyst | ABA / autism services | $18.79 | 15 min. units | $75.16 | 1 |
| ABA assessment with 2+ technicians (severe behavior) | ABA / autism services | $58.80 | 15 min. units | $235.20 | 1 |
| ABA parent and caregiver training | ABA / autism services | $18.32 | 15 minute units | $73.28 | 1 |
| ABA therapy with 2+ technicians (severe behavior) | ABA / autism services | $24.11 | 15 min. units | $96.44 | 1 |
| ABA therapy with plan changes by an analyst | ABA / autism services | $14.09 | 15 minute units | $56.36 | 1 |
| Group ABA parent training (several families) | ABA / autism services | $15.51 | 15 minute units | $62.04 | 10 |
| Group ABA therapy led by a technician | ABA / autism services | $18.60 | 15 minute unit | $74.40 | 10 |
| Group ABA therapy led by an analyst | ABA / autism services | $18.60 | 15 minute units | $74.40 | 10 |
| One-on-one ABA therapy by a technician | ABA / autism services | $12.40 | 15 minute units | $49.60 | 1 |
| Addiction (substance use) counseling | Behavioral health | $49.99 | EA | — | 2 |
| Behavioral health services (fee schedule) | Behavioral health | $33.25 | 15 min | $64.20 | 86 |
| Behavioral health subacute facility day | Behavioral health | $1,019.48 | — | — | 3 |
| Mental health assessment (non-physician) | Behavioral health | $173.88 | — | — | 2 |
| Mental health counseling | Behavioral health | $31.14 | — | — | 2 |
| Multisystemic therapy for youth | Behavioral health | $19.02 | 15 min | $76.06 | 2 |
| Outpatient psychotherapy and diagnostic evaluation | Behavioral health | $76.89 | — | $109.82 | 99 |
| Skills training and development | Behavioral health | $18.84 | OF | $57.96 | 22 |
| Therapeutic behavioral services | Behavioral health | $39.05 | OF | $82.50 | 6 |
| Therapeutic behavioral services (daily rate) | Behavioral health | $571.30 | day | — | 1 |
| FQHC / RHC visit (PPS or APM rate) | Clinics (FQHC/RHC) | $387.46 | encounter | — | 761 |
| FQHC dental visit (PPS or APM rate) | Clinics (FQHC/RHC) | $395.99 | encounter | — | 141 |
| Dental services | Dental | $79.54 | — | — | 378 |
| Durable medical equipment | Equipment & supplies | $152.30 | OF | $123.60 | 1091 |
| Enteral and parenteral nutrition | Equipment & supplies | $12.02 | day | — | 44 |
| Medical supplies | Equipment & supplies | $14.47 | — | — | 635 |
| Orthotics and prosthetics | Equipment & supplies | $460.56 | — | $185.38 | 749 |
| Adult day services | Other home & community services | $46.99 | DL | $17.42 | 44 |
| Adult foster care | Other home & community services | $164.31 | day | — | 381 |
| Assisted living / alternative living services | Other home & community services | $116.79 | day | — | 720 |
| Assistive technology support (training and set-up) | Other home & community services | $80.00 | EA | $48.92 | 18 |
| Caregiver support program benefit level (monthly cap) | Other home & community services | $2,918.00 | month | — | 12 |
| Case management / support coordination | Other home & community services | $35.00 | month | $100.00 | 49 |
| Children's waiver palliative care | Other home & community services | $228.62 | Rate | — | 18 |
| Chore services (heavy cleaning, yard work, pest control) | Other home & community services | $1,257.50 | EA | — | 6 |
| Community integration (older adults / disability waivers) | Other home & community services | $9.78 | OF | $17.38 | 12 |
| Family and peer mentoring | Other home & community services | $12.75 | hour | $20.00 | 2 |
| Family caregiver training and support | Other home & community services | $120.04 | HR | $26.98 | 8 |
| HCBS average payment rate (42 CFR 447.203 disclosure) | Other home & community services | $848.24 | day | — | 16 |
| Home modifications (accessibility) | Other home & community services | $32,500.00 | EA | — | 4 |
| Home-delivered meals | Other home & community services | $8.50 | EA | — | 1 |
| Nurse wellness counseling visit | Other home & community services | $30.00 | EA | $62.50 | 41 |
| Nursing assessment | Other home & community services | $25.03 | EA | $28.98 | 13 |
| Other waiver goods and services | Other home & community services | $2,500.00 | EA | $33.50 | 61 |
| Residential care bed-hold day | Other home & community services | $11.66 | day | — | 1 |
| Respite care (hourly) | Other home & community services | $9.91 | 1/4 HR | $21.80 | 58 |
| Respite in a facility (daily) | Other home & community services | $736.97 | day | — | 8 |
| Self-direction coaching / supports broker | Other home & community services | $23.90 | HR | $23.90 | 6 |
| Specialized medical equipment and supplies | Other home & community services | $5,000.00 | EA | — | 24 |
| Supportive housing and housing transition supports | Other home & community services | $1,175.00 | MN | — | 18 |
| Vehicle modifications | Other home & community services | $10,000.00 | EA | — | 2 |
| Home health aide visit | Home health | $66.48 | VS | — | 17 |
| Home health nurse visit (RN or LPN) | Home health | $91.05 | DL | — | 108 |
| Home health occupational therapy | Home health | $36.45 | 15 min | $145.80 | 16 |
| Home health physical therapy | Home health | $38.92 | 15 min | $155.66 | 16 |
| Home health visit (other or unspecified) | Home health | $53.94 | — | $196.92 | 2 |
| Hospice continuous home care (hourly) | Hospice | $78.34 | Hourly Rate; Rate | $78.34 | 18 |
| Hospice end-of-life visit add-on (per hour) | Hospice | $19.59 | Per unit | — | 18 |
| Hospice general inpatient care (daily) | Hospice | $1,323.83 | Rate | — | 18 |
| Hospice inpatient respite (daily) | Hospice | $616.05 | Daily Rate; Rate | — | 18 |
| Hospice residence care (daily) | Hospice | $384.03 | Rate | — | 1 |
| Hospice routine home care (daily) | Hospice | $220.44 | Capitated Daily Rate; Days 1-60 Rate | — | 36 |
| Hospital administrative (non-acute) day | Hospital inpatient | $396.20 | — | — | 1 |
| Inpatient addiction treatment or detox (per day) | Hospital inpatient | $984.56 | day | — | 182 |
| Inpatient DRG pricing input (outlier, cost ratio, stay) | Hospital inpatient | $1.00 | — | — | 1606 |
| Inpatient DRG relative weight | Hospital inpatient | $1.61 | — | — | 1224 |
| Inpatient hospital stay (DRG base rate) | Hospital inpatient | $7,118.21 | — | — | 137 |
| Inpatient hospital stay (per diem) | Hospital inpatient | $1,150.42 | day | — | 150 |
| Inpatient payment adjustment factor | Hospital inpatient | $0.227 | — | — | 235 |
| Inpatient psychiatric stay (per day) | Hospital inpatient | $1,084.50 | day | — | 184 |
| Inpatient rate add-on (education, wage, directed payment) | Hospital inpatient | $43.74 | — | — | 2 |
| EAPG relative weight (outpatient hospital or surgery center) | Hospital outpatient | $0.4233 | — | — | 714 |
| IHS / tribal outpatient visit (all-inclusive rate) | Hospital outpatient | $826.00 | — | — | 1 |
| Outpatient hospital conversion factor (APC/EAPG) | Hospital outpatient | $416.57 | — | — | 75 |
| Outpatient hospital services (fee schedule) | Hospital outpatient | $79.31 | — | — | 2 |
| Outpatient payment adjustment factor | Hospital outpatient | $1.01 | — | — | 315 |
| Surgery center payment group rate | Hospital outpatient | $446.73 | — | — | 9 |
| Additional residential staffing | IDD services | $43.81 | — | $76.67 | 21 |
| Behavior support services (disability waiver) | IDD services | $60.00 | EA | $60.00 | 12 |
| IDD residential rate component (tier table) | IDD services | $47.21 | — | — | 951 |
| Residential habilitation / group home supports | IDD services | $88.98 | — | $40.00 | 431 |
| Shared living / host home / family model | IDD services | $212.72 | Assessed Daily Rate | $30.08 | 40 |
| Supported employment (job coaching) | IDD services | $250,054.40 | hour | $101.30 | 4 |
| Transitional / crisis stabilization living supports | IDD services | $100.00 | hour | $72.00 | 3 |
| Clinical lab tests | Lab & pathology | $15.01 | — | — | 4130 |
| Nursing home daily rate component (facility-specific) | Nursing facility | $6.31 | — | — | 3777 |
| Nursing home stay (daily rate) | Nursing facility | $373.84 | — | — | 321 |
| Nursing home ventilator care (daily rate) | Nursing facility | $157.50 | — | — | 2 |
| Specialty nursing home daily rate (pediatric or IDD class) | Nursing facility | $300.00 | — | — | 11 |
| Dialysis facility composite rate (per treatment) | Other | $35.00 | — | — | 10 |
| Directed payment uniform increase (required MCO uplift) | Other | $131.36 | The magnitude of the increase and UPI varies between provider classes. 1: 197.537%, 2: 140.1137%, 3: 142.904%, 4: 87.525%, 5: 134.044%, 6: 110.483%, 7: 119.438%, 8:72.761% | — | 23 |
| Directed payment: plan payment level (% of benchmark) | Other | $40.05 | 72.6% | — | 30 |
| Doula visit (prenatal or postpartum) | Other | $387.50 | 15 min | $100.00 | 2 |
| Companion care | Personal care & attendant | $189.29 | day | $30.08 | 3 |
| Personal assistance retainer payment | Personal care & attendant | $708.76 | EA | — | 8 |
| Personal care (daily rate) | Personal care & attendant | $257.03 | DL | — | 338 |
| Personal care / attendant care (hourly) | Personal care & attendant | $9.91 | 1/4 HR | $42.92 | 44 |
| Pharmacist medication therapy management (case rate) | Pharmacy | $10.00 | — | — | 7 |
| Physician-administered drugs (J-codes) | Pharmacy | $5.07 | — | — | 1173 |
| Private duty nursing (hourly shifts) | Private duty nursing | $16.42 | 1/4 HR | $61.84 | 36 |
| Waiver nursing (RN or LPN, by the 15 minutes) | Private duty nursing | $20.99 | 1/4 HR | $100.00 | 26 |
| Anesthesia conversion factor | Physician & professional | $21.20 | — | — | 1 |
| Community health worker education and training | Physician & professional | $23.74 | — | — | 14 |
| Physician and practitioner services (fee schedule) | Physician & professional | $230.28 | EA | $73.76 | 16401 |
| Physician fee schedule conversion factor | Physician & professional | $20.44 | — | — | 4 |
| Practitioner payment adjustment (percent or set amount) | Physician & professional | $0.80 | — | — | 1 |
| Imaging and radiology | Radiology | $45.67 | — | — | 3516 |
| Cognitive rehabilitation therapy | Therapy (PT/OT/speech) | $12.61 | 15 min | $50.44 | 18 |
| Nutrition counseling (dietitian) | Therapy (PT/OT/speech) | $15.86 | EA | $63.44 | 7 |
| Occupational therapy | Therapy (PT/OT/speech) | $37.65 | EA | $118.10 | 22 |
| Occupational therapy evaluation | Therapy (PT/OT/speech) | $61.15 | — | — | 44 |
| Orthotic and prosthetic fitting and training | Therapy (PT/OT/speech) | $28.28 | 15 min | $113.12 | 29 |
| Other therapy services | Therapy (PT/OT/speech) | $15.30 | — | — | 11 |
| Physical therapy | Therapy (PT/OT/speech) | $19.87 | EA | $74.90 | 22 |
| Physical therapy evaluation | Therapy (PT/OT/speech) | $59.43 | — | — | 44 |
| Speech-generating device evaluation | Therapy (PT/OT/speech) | $74.34 | — | — | 10 |
| Speech-generating device therapy | Therapy (PT/OT/speech) | $62.49 | — | — | 10 |
| Speech-language evaluation | Therapy (PT/OT/speech) | $80.64 | EA | — | 46 |
| Speech-language therapy | Therapy (PT/OT/speech) | $143.12 | EA | — | 28 |
| Swallowing and feeding evaluation | Therapy (PT/OT/speech) | $51.60 | — | — | 11 |
| Swallowing and feeding therapy | Therapy (PT/OT/speech) | $51.02 | — | — | 9 |
| Air ambulance transport | Transportation | $2,632.24 | — | — | 3 |
| Ground ambulance transport | Transportation | $168.43 | — | — | 9 |
| Non-emergency medical transportation (NEMT) | Transportation | $10,000.00 | EA | — | 2 |
| Waiver transportation (to community activities) | Transportation | $0.73 | MI | — | 16 |
| Eyeglasses and contact lenses | Vision & hearing | $244.76 | — | — | 27 |
| Hearing aids and hearing services | Vision & hearing | $72.19 | — | — | 12 |
Most-compared billing codes in Washington
Where Washington ranks among states for codes published widely. Rank 1 = highest rate.
| Code | Service | Washington | All-state median | Rank |
|---|---|---|---|---|
| 10004 | Physician and practitioner services (fee schedule) | $21.21 | $35.52 | 18 of 19 |
| 10005 | Physician and practitioner services (fee schedule) | $36.31 | $60.63 | 18 of 19 |
| 10006 | Physician and practitioner services (fee schedule) | $25.03 | $39.90 | 18 of 19 |
| 10007 | Physician and practitioner services (fee schedule) | $46.25 | $76.74 | 17 of 19 |
| 10008 | Physician and practitioner services (fee schedule) | $27.14 | $46.94 | 17 of 19 |
| 10009 | Physician and practitioner services (fee schedule) | $54.08 | $93.03 | 18 of 19 |
| 10010 | Physician and practitioner services (fee schedule) | $37.84 | $65.32 | 18 of 19 |
| 10021 | Physician and practitioner services (fee schedule) | $26.75 | $49.77 | 18 of 19 |
| 10030 | Physician and practitioner services (fee schedule) | $68.41 | $119.43 | 17 of 19 |
| 10035 | Physician and practitioner services (fee schedule) | $41.28 | $70.26 | 18 of 19 |
| 10036 | Physician and practitioner services (fee schedule) | $21.21 | $35.41 | 18 of 19 |
| 10060 | Physician and practitioner services (fee schedule) | $60.96 | $76.16 | 13 of 19 |
| 10061 | Physician and practitioner services (fee schedule) | $103.77 | $129.16 | 14 of 19 |
| 10080 | Physician and practitioner services (fee schedule) | $63.45 | $78.73 | 13 of 19 |
| 10081 | Physician and practitioner services (fee schedule) | $99.75 | $127.86 | 15 of 19 |
| 10120 | Physician and practitioner services (fee schedule) | $61.92 | $77.44 | 15 of 19 |
| 10121 | Physician and practitioner services (fee schedule) | $102.05 | $135.29 | 15 of 19 |
| 10140 | Physician and practitioner services (fee schedule) | $69.37 | $86.45 | 14 of 19 |
| 10160 | Physician and practitioner services (fee schedule) | $55.04 | $69.52 | 15 of 19 |
| 10180 | Physician and practitioner services (fee schedule) | $104.34 | $148.10 | 16 of 19 |
| 11000 | Physician and practitioner services (fee schedule) | $14.14 | $24.52 | 18 of 19 |
| 11001 | Physician and practitioner services (fee schedule) | $7.45 | $12.36 | 19 of 19 |
| 11004 | Physician and practitioner services (fee schedule) | $289.52 | $437.21 | 17 of 19 |
| 11005 | Physician and practitioner services (fee schedule) | $394.81 | $573.02 | 16 of 19 |
| 11006 | Physician and practitioner services (fee schedule) | $356.97 | $542.16 | 17 of 19 |
| 11008 | Physician and practitioner services (fee schedule) | $139.12 | $206.56 | 16 of 19 |
| 11010 | Physician and practitioner services (fee schedule) | $146.76 | $225.24 | 17 of 19 |
| 11011 | Physician and practitioner services (fee schedule) | $154.03 | $229.46 | 16 of 19 |
| 11012 | Physician and practitioner services (fee schedule) | $210.40 | $326.26 | 17 of 19 |
| 11042 | Physician and practitioner services (fee schedule) | $32.87 | $50.80 | 17 of 19 |
| 11043 | Physician and practitioner services (fee schedule) | $80.64 | $134.21 | 16 of 19 |
| 11044 | Physician and practitioner services (fee schedule) | $116.95 | $182.12 | 16 of 19 |
| 11055 | Physician and practitioner services (fee schedule) | $8.03 | $14.80 | 19 of 19 |
| 11056 | Physician and practitioner services (fee schedule) | $11.47 | $20.38 | 19 of 19 |
| 11057 | Physician and practitioner services (fee schedule) | $14.71 | $26.13 | 19 of 19 |
| 11102 | Physician and practitioner services (fee schedule) | $17.58 | $32.23 | 18 of 19 |
| 11103 | Physician and practitioner services (fee schedule) | $10.32 | $18.65 | 18 of 19 |
| 11104 | Physician and practitioner services (fee schedule) | $22.17 | $40.43 | 18 of 19 |
| 11105 | Physician and practitioner services (fee schedule) | $12.42 | $22.05 | 18 of 19 |
| 11106 | Physician and practitioner services (fee schedule) | $27.14 | $49.21 | 18 of 19 |
Managed care in Washington
51 plans on record, 53 state-directed payment records.
Who sets the rate, line by line →Recent rate changes and notices
Frequently asked questions
Where does Washington publish its Medicaid fee schedules?
Washington publishes rates across 584 official documents (fee schedules, rate notices and bulletins). Every rate on this page links to its source document.
How many Medicaid rates does Washington publish?
42,408 rates are current across 126 services and 24 programs, with 241,092 versions on record since 2006-07-01.
Do Washington Medicaid managed-care plans pay the fee schedule?
For 14 of 22 service lines, plan contracts or state law set a rule plans must follow (a floor, a state-set rate or a required pass-through). For the rest, plans negotiate. See the managed-care page for each line's rule and citation.
Other states
Your Washington rate cardYour codes, what Washington pays, what plans must pay, and every change in 2026.